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Holiday Tips for Nursing Parents

by Dr. Sarah Winward, ND IBCLC

The holidays can be the most wonderful time of the year. But with a new baby in the post pandemic world, the holidays can be downright stressful. Between navigating your newborn and trying to decide what events to attend, you’re also worried about you or them getting sick. 

As a Naturopathic Doctor and board certified lactation consultant, parents often come to me with concerns at this time of the year. Things like “can I have a drink or two at this holiday party?” or “how do I reduce the risk of my baby getting sick?” So, I’ve put together my top tips for navigating the holiday season with a newborn baby!


Attending parties and events.

First and foremost, don’t feel pressure to attend anything. You’ve just had a baby, your primary job is to rest and recover. Pairing down the expectations on yourself can make things a lot more manageable. It’s also totally okay to cancel last minute if you’ve had a rough day or if baby is having an especially hard time. 

But, if you have something you’re looking forward to going to, it can be a refreshing change of pace! Just take it easy on yourself. Don’t expect to stay the whole time and be ready to bail quickly if you need to. 

Expect that baby will get over stimulated, especially if they’re getting lots of attention. Busy environments can make feeding them less efficient. You may find that they are hungry more frequently or that they make up for it by cluster feeding after the event. If you’re visiting family or friends, it can be helpful to have a quiet room to feed and change your baby in- ask about this before you go! 

A quiet room may be just what you need!

Minimising germs

Parents are often worried about people holding and kissing their newborns. And rightly so. I highly recommend wearing your baby. A soft wrap can be easy to get them in and out of and isn’t super bulky for you. It will take some practice before hand but there’s so much benefit to this. 

  • Baby will feel safe and secure close to you, even in a crowded environment
  • People might come up to baby in a stroller or a bassinet, but they probably won’t get their face right up into your face to see your baby
  • It’s easier on your body than holding them in your arms the whole time

Be choosy about who can hold your baby and don’t feel bad saying no, you can always say that baby has been having a rough day and you’d rather no one hold them! If there are people that you’d like to see your baby, make sure they wash their hands first and that everyone knows not to kiss them.

If you are worried about a potential exposure, nursing is your best friend. Your body makes immune factors to help baby fight off anything in the environment. The trick is, this communication happens through your gut, you need to get those germs into your mouth (weird, I know). But, the easiest way to do this is by kissing your baby! That way, any germs that they have on their face get into your body and your milk can start making immune factors. 

Baby wearing means your hands are free to enjoy the party food!

Alcohol

This is one of the most common questions I get postpartum- “Can I enjoy a drink now that baby is born?”. The answer is yes, you can!

Alcohol gets into human milk in the same amounts as it’s in your blood. That means that if you’re at the legal driving limit your blood contains about 0.05% alcohol. If you feed your baby, they will then metabolize that alcohol, so the amount that gets into their blood is very very small. 

You don’t have to pump and dump either. As alcohol leaves your blood, it will also leave your milk. Pumping doesn’t make this happen any faster. 

In general, when it comes to alcohol, if you can drive you can nurse. And, if you’re ever unsure, you can always wait an hour and then nurse. 

One more tip- if you can get the timing right. The best time to nurse is while you’re having the drink. It takes about 20 minutes for your blood alcohol levels to start to rise, and then your baby will hopefully have a longer stretch while you’re digestive system does its work.

You don’t need to skip out on the holiday cheer!

Sarah Winward
CO-FOUNDER: DR. SARAH WINWARD, ND IBCLC Hi! I’m Dr. Sarah, Naturopathic Doctor, Board Certified Lactation Consultant and Infant Craniosacral Therapist (mouthful, I know). What all those titles really mean is that I live and breath babies and lactation. I’m also mom to 2 boys, one of whom breastfed until he was 3 and the other is still going! Background and experience: I completed an Honours Bachelor of Science in Medical Physics and Applied Radiation Sciences at McMaster University. About a year into my Masters in the same field I realized that I was meant to work with people, not with machines and computer programming. Searching for a path in the health care world led me to Naturopathic Medicine- the perfect blend of science and traditional wisdom that focuses on the patient as a whole person. I graduated from the Canadian College of Naturopathic Medicine in 2016. After graduation I went on to study lactation, first at the International Breastfeeding Centre, then among a number of community practitioners. With 500 hours of hands on lactation support under my belt I wrote my IBCLC exam in 2020, while in lockdown.

Are you preparing for your best possible birth? 

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Are Prenatal Classes Really Necessary?

-Dr. Olivia Chubey, ND

Yes! Yes! A resounding YES! 

In case we were being too subtle

You are setting yourself up for failure if you don’t take a prenatal class.  

(I know that sounds harsh, but this is too important of a topic to tiptoe around.)

I know what you’re thinking: “Well of course you would say that, you teach prenatal classes!”  True! But, why do I teach them? 

Because I truly believe that a GOOD prenatal class is the #1, (yes, NUMBER 1) factor that leads to improved satisfaction surrounding birth. And I’d argue satisfaction with your birth experience is pretty important. 

Here’s why this really matters:

About 1 in 4 people who have given birth in the UK, and 1 in 3 in the US, describe their birth as traumatic. (Unfortunately, we don’t have stats in Canada). Not just hard, not just tiring, long or painful, but TRAUMATIC.  The birth of your baby should not be a traumatic experience! Even if there are unexpected circumstances, you should not come away from your birth feeling traumatized. It has always been my goal to reduce this statistic. 

Knowing this, It honestly shocked me to learn that only 50% of pregnant families in the GTA take prenatal classes.  But, I understand why this happens. 


  1.  You’ve been told childbirth is unpredictable and the doctor will “tell you what to do”.


Yes, birth is unpredictable. And yes, your doctor can tell you what to do, but is this how you want to experience birth?  In an effective prenatal class you learn techniques that help you cope with the marathon that labour can be.  Being prepared means you have the tools and skills to cope, even when unexpected things arise.  Each birth is indeed a unique and individual experience, and yet, there is a benefit to knowing what to generally expect and what to do.  Even explorers had a compass to navigate unknown lands.  

Your OB is definitely an important resource but they don’t arrive until the baby is literally ready to be born. Unless there are complications. (I like to say a birth is going well when you barely see the OB). You will have some assistance from the nurse but their primary role is to perform regular medical checks of you and the baby. Your birth is likely to progress normally, which means you and your partner are largely on your own: first labouring at home, then making your way to the hospital, then waiting in triage to be assessed, and then continuing in the labour and delivery room. 

It is very possible that some of the recommendations from your nurses and even your OB will not be evidence based. Many things are simply hospital policy or individual bias of the care provider. Did you know that on average it takes about 20 years (yup) for policy to catch up to current evidence. The unfortunate reality is that the onus is on you to come armed with knowledge, questions and the ability to advocate for yourself and your baby. 


  1. “I’m going to get an epidural, so I don’t need to prepare or learn coping skills”

In the movies: Water breaks. Rush to hospital. Get an epidural. Aaah, relief.

In reality: Early labour may last days. You get to the hospital triage and wait for a long time before getting assessed. Hopefully you didn’t arrive too early (or you’ll be waiting some more). Eventually you get to your labouring room and you request an epidural. If it’s a busy time (labour and delivery is the busiest place in the hospital), you may be waiting up to a couple hours more. Very occasionally, the epidural doesn’t work.  Or, your labour is progressing so quickly that there is no time to get an epidural. 

No one seems to tell you that you may be in labour for a long time before you get an epidural. So if getting an epidural is your only “coping” mechanism, you’ll be in for a rough ride. 

Learning comfort measures and relaxation exercises for labour and birth is not just for those wanting a natural birth. Learning these things gives you tools you can use in any birth situation which increases your chance for a positive birth experience. 

Read more here → Quick Tips on Having a more Comfortable Labour 


  1. “I’ve heard that hospital classes are not very useful.” 

“I can’t find one that works with my schedule”. 

“I’d rather have just the information that applies to me and my birthing situation and preferences”  


I get it, you have access to all the information you could ever dream of on the internet. However, it takes time to filter through all of it and do you even know what to look for? If you’ve never given birth before, how will you know what “method” to learn? What if someone who has supported many families in a range of birth situations was able to teach you the inside tips and tricks to help you feel calm and confident during labour and birth. Yes, being calm and confident during childbirth is entirely possible! In fact I believe that every pregnant person DESERVES to be calm and confident during this very important life changing event! 

If group classes and their schedules don’t work for you – consider a private prenatal program. I’ve noticed that clients seem to get more out of private classes because I’m able to individualize information. Clients also love that the classes are scheduled around their convenience. 


  1. Birth has basically been a terrifying mystery your whole life.

    I remember the initial joy I had when learning about birth in medical school.  I finally understood what goes on, from implantation, pregnancy and birth.  It resonated with me, my intuition, it was normal – I didn’t have to be afraid of it.  My education empowered me. However,  the joy was quickly followed by frustration.  Why did it take a medical degree to learn this, why didn’t I know in my prime “child bearing age” anything about birth outside of the dramatized ER births on television. 

Most people are very afraid of giving birth, and don’t really want to think about it. But knowledge truly is power. If you understand what you body is doing during labour, how the muscles work, how your baby is working with you then you can learn how to work with your body and not against it.   

Read more here → How Can My Partner Prepare for My Birth? 


Ok, so prenatal classes are essential for a positive birth experience. But how do you figure out which class to take? Not all classes are equal – do your research. For your convenience I’ve created the following checklist:

Will your prenatal class include ALL of the following? 

  • -Ends when you are 37 weeks pregnant or earlier
  • -Teaches and practices in-class practical relaxation exercises that you can use
  • during labour (helpful for after birth too!)
  • -Teaches your partner how to be a GREAT birthing partner
  • -Covers stages of labour and birth from a non-fear based approach
  • -Covers the birth plan in an evidence-based approach so you feel educated and empowered about what to expect and how to manage labour and childbirth
  • -Includes a workbook with exercises to help you prepare mentally and emotionally
  • -Includes additional resources such as audio recordings, videos and props
  • -Allows you to contact the instructor directly in case you have any questions or concerns
  • -Treats birth as a physical and emotional experience and not simply a textbook reading assignment. 
  • -Celebrates the miracle and power of pregnancy and childbirth!

If you’re on a budget, the City of Toronto has a free online prenatal class here “Welcome to Parenting”

Yes, that’s right, I’d rather you take ANY prenatal class, even if it’s not mine. 

However, I and another birth-loving ND’s and doula colleagues, have created our Confident Birth Prenatal Program specifically from our experiences as mothers who have given birth, and as doulas who have supported birthing families. From our many years working in this area, we observed and listened. The result?  A prenatal program that meets all the criteria above. And as the name implies, you WILL feel more confident and prepared for childbirth. 

Learn more about the Confident Birth Prenatal Program

I want families to feel empowered, calm and confident. Getting educated and having resources helps.  I teach and work with families because I LOVE sharing all the wonderful, interesting, mind-blowing things that your body does in labour and how you can help it do its job easier.  

We’re so passionate about helping families get a positive start to parenthood through positive birth we offer not just one but two different prenatal programs! 

Confident Birth Prenatal Program

HypnoBirthing – The Mongan Method Program

Would you like to learn more about how a doula and naturopathic doctor can support you in pregnancy, childbirth and postpartum? Click here to book a free 15 min Meet and Greet today! 

** Your prenatal class with a naturopathic doctor may be eligible for coverage by your work benefits/ health insurance plan. Inquire with us today! 

Dr. Olivia Chubey, ND
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How Can My Partner Prepare for My Birth?

by Dr. Sarah Winward, ND IBCLC


Is my partner truly prepared to help me in childbirth?

Do a quick google or amazon search on “childbirth preparation” you will get a list of results that are overwhelmingly geared towards you, the pregnant person. You might notice that there are very few books written that would help prepare your partner for childbirth.

Why is this a problem for me?

How you are cared for and supported during childbirth affects how you give birth and how you feel about it. How you feel about your birth experience can also influence how you feel about your own ability in being a mother as well as affect your chance of developing postpartum depression and anxiety. Knowing this, it’s pretty clear that ongoing emotional and physical support during the very transformative experience of birth is of the utmost importance.

What about a doula?

A doula is a person who provides continuous and on-going emotional, physical and informational support for the labouring person. It has been shown that doulas help to reduce the rates of interventions, including epidural use and c-sections and help to increase reported satisfaction in birth experience. In other words, having a doula increases the chance of having HEALTHY AND HAPPY parent and baby.

But what if I can’t have a doula?

Not everyone can access a doula. Even though having doulas would actually reduce health costs, increase positive outcomes and would be a good basic addition to any healthcare system, hiring a doula is not possible for everyone.

At the time of this writing, COVID-19 virus (simply referred to as coronavirus) is emerging as a global and local public health concern that is resulting in changes in hospital policies. Hospitals are restricting the number of people who can attend births, in some cases reducing it to only one person, usually just your partner. As a doula, when I attend births, the more support the birther can receive, the better their experience. Sometimes, in addition to their partner and me (their doula), their own mother and/ or a friend will be there too. So this change in policy can greatly impact your birth experience and well-being.

How should my partner best prepare to support me? 

Here are some tips to help your partner be your “doula”:

Communication! Be honest about your fears around childbirth and be honest about your partner’s strengths and weaknesses in handling high stress situations. Play up those strengths and how they can be best used to help you during labour and childbirth

Take a high quality prenatal class that focuses on teaching techniques and skills that your partner can use to help you during labour and childbirth. We at Your Downtown Doula offer the Confident Birth Prenatal Class for a comprehensive approach to help you feel relaxed and confident during childbirth and labour.

Labour at home for as long as possible. If the concerns around infection still exist at the time of your childbirth, then reducing your hospital stay is a good idea. Your partner can help you with relaxation, help distract you, do massage and attend to your basic needs. Doing most of your labouring at home can also reduce unnecessary interventions.

A great book for partners is Penny Simkin’s The Birth Partner. It is specific to doulas and partners and contains very comprehensive information.


Want to learn more about our Confident Birth Prenatal Program?

Click here to sign up for a complimentary virtual Meet & Greet with one of our instructors (by the way, did we mention that they’re all Naturopathic Doctors!)

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Top 5 Tips for Self Care During Pregnancy

by Dr. Sarah Winward, ND IBCLC

Real talk, the pregnant body is a weird place to live. Your skin stretches in ways you have no control over. You leak, if you’re lucky it’s just increased vaginal discharge and colostrum. If you’re unlucky it’s peeing a bit when you sneeze. Sometimes you sleep, sometimes you don’t, and sometimes you wake up so stiff that you wonder if you’ve been in a brawl and just don’t remember. To say the least, it’s a lot to get used to. At 32 weeks pregnant, I’m right in the middle of the third trimester, and the pregnancy weirdness is in full swing.

It’s become obvious to me that self care is extremely important, now more than ever. The more I take care of myself, the more comfortable I am with my ever changing body, the more I feel connected to my baby, and the more excited I get about giving birth. So, I wanted to share with you my top 5 favourite self care practices for pregnancy.


1. Positive Self Talk

I’m putting this one first and foremost, because you can’t do any of these other practices without speaking to yourself in a loving voice. Remember that you’re growing a human being! I’ve found it helpful to reframe the changes I’m noticing. For example, instead of thinking that the veins I’ve noticed in my legs are ugly, I remind myself that I have about one and a half times more blood than I used to and my body is working to accommodate it.  Plus, how cool is it that my body was able to make all that extra blood to nourish my baby.


2. Dry Brushing

Dry brushing is a simple technique used to increase circulation to your skin and promote lymphatic drainage. Using a coarse bristle brush, and light strokes, you brush from your extremities towards your heart. You can find a tutorial here. I love doing this right before hopping into the shower because my skin feels super soft afterwards and it gives me an opportunity to pay attention to every part of my body and notice how it’s changing. It’s also possible that it may help decrease your chances of getting stretch marks, so that’s a bonus.


Just remember, you’re body is doing a lot right now. You should be impressed!

Dr. Sarah Winward

3. Self Massage

I’ve added this as part of my shower routine as well, and it doesn’t have to be super complicated. I just take some extra time applying moisturizer, I use coconut oil, after I shower. I usually give my belly, thighs and hips a bit of extra love using a circular motion and light touch. Again, I love this because it gives me time to see how my body is changing. But it also means that I am touching myself with my own hands, getting comfortable with what feels different. This is another opportunity to be really loving to your body, and appreciate everything that it’s able to do to sustain a new life.


4. Spending Time Naked

I’ve done this 2 ways. The first is that my shower routine has gotten longer, so I am spending more time naked with myself then. I also take some time to do yoga in the mornings. The mornings work for me because I’m not sleeping well (surprise, surprise) so I’m usually up much earlier than the rest of my house. I can get in a 20 minute prenatal flow without being interrupted. And I have been choosing to do this naked. Yoga is amazing because it connects you with your breath. It brings you into the present moment and it reminds you to be in your body without judgement. I’ve been enjoying this one, but there are tons out there that are free to access. I love this practice because it is super gentle, it reminds you to put your hands on your belly and to connect with your baby. Being comfortable at least partially naked will become important, because after your baby is born the best place they can be is skin to skin with you, you can find out more about that here. The more comfortable you are, the more you’ll want to hang out skin to skin, and the better for both you and your baby. 


5. Exercise

I have been lifting weights for years. So, it was natural for me to want to continue into my pregnancy. Although, I did take a bit of a break during the most exhausting parts of the first trimester. As long as you’ve been given the ok by your care provider it is safe to continue most exercises through pregnancy. But, it is important to check in. How do you feel while your doing it? How do you feel after? I love lifting because it really shows you what your body is capable of, you can see your own strength. But, you can also see how things shift. I stopped doing pushups  at around 25 weeks and started doing wall pushups because I didn’t feel like I could maintain good form. I’ve recently started feeling the same about deadlifts. And that’s ok, because my core is shifting to accommodate a tiny person.

In my second trimester, I also started attending prenatal exercise classes. I highly recommend this because it gives you a chance to connect with other pregnant people. And you get solid guidance from fitness professionals who specialize in pregnancy and postpartum, so they can help you modify appropriately when you need to.

Just remember, you’re body is doing a lot right now. You should be impressed! Take the time to thank your body and take care of it. 


This article is meant to provide information only, it does not substitute for personalized medical care.

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Do I *Really* Need a Birth Doula?

Dr. Olivia Chubey, ND

Yes!

And no. And Maybe.

It depends. On a lot of factors. Let’s break this down in an easy way. Take a few minutes and ask yourself the following questions:


  1. What is important to you in your birth experience?
  2. Do you have a birth companion?
  3. What kind of support do you expect from your birth companion?
  4. Are they capable of giving your that support?
  5. Do they have the tools and knowledge to support you?

If you answered YES to #2 but NO to #4 and #5.  

You *might* be able to get away without a doula if you take a prenatal class that focuses on educating you and your birth companion on coping techniques, how to use them in labour, and common interventions – for example our Confident Birth Program.  You may find that your birth companion may be enough, armed with the information they have learned to help you with your answer in #1. 

If you answered YES to #2, #4, #5 you may decide to still work with a doula for one of the following reasons: 

  • I understand that my labour may be longer, and I value the idea of my partner being able to rest so that they may help me more after baby is born. 
  • My partner feels anxiety regarding whether they can be whatever I need them to be/remember it all etc, so it would be good to have knowledgeable and comforting help in addition. 

(*Research has shown that the most positive birth experiences for fathers were ones where they had continuous support by a doula or a midwife.)

  • I know that statistics show that moms have better birth experiences and less medical interventions when a doula is present

(*Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons.)

  • I desire a low-intervention and/or no-intervention labour and understand the skill set and assistance a birth doula provides can support those goals even further then I can alone, or solely with my birth companion. 
  • I experience anxiety with hospitals, medical equipment, etc.
  • I understand a birth doula may have other areas of help and support that they can share with me to smooth my transition into parenthood. (For example, Lactation Support)
  • I feel birth is more than just a biological event, and would like to work with someone who treats it more holistically. 

If you answered NO to #2, I would highly recommend a doula. 

If this has piqued your interest or you’d like some more questions answered, you can book a complimentary Meet & Greet with a doula from our collective today! We’ll spend about 15 minutes with you in a video chat to answer you personal questions and help you decide if we’re the right match to support you in your birth!

Dr. Olivia Chubey, ND

*Evidence Based Birth, “Evidence on: Doulas”, May 4, 2010, Rebecca Dekker, PhD, RN.

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Alternative Options to Pain Medications

To epidural or not to epidural… is that even the important question? 

Dr. Olivia Chubey, ND

Do you want an epidural?

Great!

Do you want to labour and birth without an epidural?

Great!

Do you want to wait as long as possible before getting one?  Or, get it as soon as possible?  

Regardless of your personal preferences or medical necessities, in every circumstance – the real question is ‘can I cope with this’? 

Cope with discomfort, with pain, with the pressure of being a parent, doing the right thing for me – for baby…and the list of things goes on and on….   

The birth of your baby and the labour process, is a complex, enigmatic, beautiful collision of science, faith, luck, love and transformation.  But when discussed in modern science – it is usually reduced to pain. (If I were to extrapolate further, the entire birth experience often is reduced to: whether you will tear, what gender you are having/do you have a name, and whether you will breastfeed)

And I get that.  Pain is scary.  We are also wired to want to avoid pain, just like birth – it’s human nature, so it’s no wonder it’s become such a focus of our energy.

So whether or not you want, or need, the epidural, there are so many techniques/ways of being that can help get you more comfortable and able to cope – so that birth can be more than just about the pain.

Here is a quick breakdown of some of them

  1. Breathing Techniques
  2. Visualization techniques 
  3. Relaxation techniques
  4. Using hand on manual therapies
  5. Positions
  6. Water
  7. Music 
  8. Affirmations 
  9. Education – understanding your body and also the hospital interventions
  10. An active birth companion [partner doula or otherwise] and supportive healthcare team

I want you to know these and how to use them. 

I am deeply passionate about sharing the education, training and experience that I have with you. I want to support you through one of your most vulnerable experiences. 

My hope, by doing so, is to further reduce the statistic of you calling your birth a ‘traumatic experience.’ 

Connect with me, or anyone on our team – we are all just as passionate about this!

We can talk about what your needs are and suggest what course of action we recommend based on your unique needs. 

Or, if you just want to learn these techniques – click here to learn more about our Confident Birth Program or email info@yourdowntowndoula.com!

Dr. Olivia Chubey, ND

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You *just know* how to parent!

Dr. Kim Abog, ND

Have you ever had a strong hunch about something and it turned out to be true? Have you ever defied that little voice in your head (much to their dismay) and felt regret about it? 

As a parent, you may have already had several introductions, friendly or rude, with your parental gut instinct

“How to Trust Your Intuition”

Planning for parenthood can feel overwhelming.

When people become parents, they may naturally become open to learning about different aspects of parenthood and childcare to brace themselves for raising children. Many seek counsel from books, families and friends, classes, websites, and doctors and specialists. 

While the above traditional methods can help to sharpen child-rearing acuity, they may not be enough to prepare you for the imperfect mess of parenthood. Yes, that part of parenthood where everything you’ve read, seen, heard, or learned gets thrown out the window and seems to contradict what your child needs. That is because there is simply no way (yet!) to pass on instinctual information and intuition.

“Something feels wrong.” You’re probably right.

Your gut instinct, also known as gut feelings or intuition, is your natural ability that helps you decide what to do or how to act without thinking. Gut feelings are thought to be signals communicated between your brain to and from your digestive tract. Some experts also postulate that emotions play a key role in decision-making (naming gut instincts as somatic markers). 

There is still a lot to learn about the engrossing overlaps between the worlds of psychology, neurobiology, and gastroenterology. One thing experts generally agree on is how parents (research-wise, mothers in particular) can be more sensitive or susceptible to particular cues and signals from their children. 

Science has not fully caught on with Nature’s Human Parent Design yet but we are seeing some fascinating evidence of intuition in action. 

The Pregnancy Brain 

Mom, your brain will adapt!

A 2017 study has shown that pregnancy causes substantial changes in brain structure, primarily reductions in gray matter volume. Gray matter loss is not necessarily a bad thing in pregnancy, because the volume reductions occurred in regions that enable us to read social cues (ie. reading baby’s behavior intuitively). These same regions had the strongest response when mothers looked at photos of their infants. Gray matter loss was only seen in (new) mothers but not in fathers. It’s not clear why women lose gray matter during pregnancy but this may be evidence that brain remodeling may play a role in helping women transition into motherhood and respond to the needs of their babies. These reductions lasted for at least 2 years postpartum.

New Parent: trust your gut!

The Sixth? Seventh? Eighth? Sense

There are also some studies that have noted the significant value of using solely the parent’s recognition of baby’s cries, touch, and/or concern in proceeding with the management of fevers and ear infections. Generally speaking, parental concerns may be more useful to exclude the possibility of health issues than “rule in”. These global findings also amplify the need for care practitioners and advocates to promote and prioritize parental well-being in health practice in order to strengthen parental intuition

You just know.

Parents: You’ve got this!

Parenthood is a steep learning curve, and one that you’ll be on for an indefinite amount of time. You will always be a parent. You just become more comfortable with the uncertainty. Getting comfortable means trusting and believing in yourself enough to know that you are capable of taking care of and advocating for your family. It is also in knowing that there is no one right way to do so. You got this; you always have. 


Dr. Kim Abog, ND

 

Sources

https://pubmed.ncbi.nlm.nih.gov/23591865/

https://www.ncbi.nlm.nih.gov/books/NBK75333/

https://www.racgp.org.au/afp/2012/september/a-is-for-aphorism

Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.

  • What tests and screenings will be offered and when
  • When to sign up for prenatal education and what types to consider
  • Things you should think about that your care provider may not mention
  • Links to helpful resources

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Considering a VBAC*? You Need to Read This!

Dr. Ee Von Ling, ND

*There is a shift towards using the term TOLAC (Trial of labour after C-section) instead of VBAC (Vaginal Birth after C-section). In many ways this term is preferred, less emotionally loaded and less cumbersome than using VBAC. Thus, I will be using both VBAC and TOLAC interchangeably in this post. 

One of the very first births I attended as a new doula was a home VBAC. The parents had taken my HypnoBirthing classes and requested me to be their doula. At the time I was just so excited to be going to a home birth that I didn’t even think about the significance of this being a TOLAC.

The mother told me her birth history and the events that had led up to her c-section – “failure to progress at 9cm”. I took all her info and simply reassured her, “every pregnancy is different and so this will be a different experience than your first one”. And it was different. Amazingly different. The labour and birth progressed just like any other normal labour and birth and the mother had her successful home VBAC!

This VBAC homebirth imprinted on me that VBACs were no big deal and they were just like any other birth.

It wasn’t until I started having more conversations with pregnant clients and doctors and reading comments in mommy forums and news articles that I would realize that VBAC’s were seen as A. BIG. DEAL. Words like “highly risky”, “uterine rupture”, “endangering baby”, “dangerous for mom”, “irresponsible” almost always accompanied the VBAC discussion. It was bad enough that women had fear of normal labour and birth itself, but having a past c-section somehow put a whole other layer of fear and worry on top of that.

So I double checked the evidence and the statistics around VBAC and risks and benefits.  Contrary to the conversations, the numbers showed that a vaginal birth after a previous c-section was a reasonably safe and healthy choice for most women. The absolute risks were very low and the success rates for attempted VBACs were actually quite high. In fact, the risks for a planned repeat c-section were worse. If you’d like to learn more about the pros, cons and risks around attempting a VBAC, you can read this very excellent handout created by the Ontario Association of Midwives here.

Over the last several decades VBAC rates have gone up and down. According to US statistics, In the 1990’s about 30% of those who had a previous C-section attempted a VBAC. Today that number is about 13%. These numbers have fluctuated because of changes in the practice guidelines of obstetricians. VBAC births themselves did not become more dangerous, but practice guideline updates recommended more medical requirements in order to offer them. These changes influenced the perception and accessibility of attempting VBACs – OB’s became less supportive of them and the public developed a bigger fear of them. Understand that the risks and outcomes for those who attempt VBACs did not change in the last 40 years. 

Being able to go through a trial of labour after C-section might be a very significant and impactful choice. For some, being able to vaginally birth helps them to heal a previous birth trauma and reclaim the birth experience for themselves. As a medical industry, we should not take the personal decision to try for a VBAC lightly and we should provide unbiased information and support for that person. 


If you had a previous C-section and are now considering a VBAC for your next childbirth, here are 6 things you can do to help improve your chances of birthing your baby vaginally: 

  1. Choose a supportive provider: This might be the most important factor of all. Having a midwife improves your chances of giving birth vaginally and with fewer restrictions around VBAC. If you are not able to get a midwife, make sure your OB is VBAC supportive. How will you know if they are VBAC supportive, ask them outright: 

  • Are you supportive of VBAC?
  • What is this hospital’s TOLAC rate? How many of your own patients chose TOLAC and how many of those result in VBAC?
  • What would be your advice around increasing my chances of achieving a VBAC?

You will get a sense of their own attitudes and biases based on how they respond to these questions. 

  1. Learn techniques so you can labour at home for as long as possible: Choose a program that includes learning and practicing breathing exercises, visualizing, releasing past fears. Our clients who have been able to VBAC took HypnoBirthing classes, listened to positive birth podcasts, read books about empowered birth by Ina May Gaskin and Penny Simkin. From our own collective experience supporting our own VBAC clients, we teach a special condensed version of our  Confident Birth Prenatal Program that focuses just on the relaxation exercises and techniques to help you be calm and confident during labour.  

  1. Ensure the baby is in a good position: Head down is not enough!  Baby’s position with their back on the left side so you feel kicks or the big movements on the right (referred to as LOT) or baby’s back is in the front so you don’t feel a lot of kicks or movement elsewhere (referred to as OA) are the ideal starting positions for baby. A baby in the posterior position (or OP or “sunny side up”) may have a harder time being born vaginally. Perhaps during your previous birthing the baby was in this posterior position, which can lead to slow or arrested labour. 

There are ways to help encourage a baby to get into the ideal starting position for birth. Daily positional awareness, acupuncture, massage, chiropractic, osteopath and physiotherapy treatments may help. 

  1. Get your labour to start naturally: If you labour starts naturally, this will help you avoid further interventions that might increase the risks of a TOLAC. Speak with your midwife or doula about ways to start labour that are safe for those who’ve had a previous c-section.

  1. Try to avoid an epidural: An epidural can limit movement and slow down labour (if started early in labour). If labour slows down, then artificial oxytocin will be needed to help progress the labour. But using artificial oxytocin in someone who had a C-section increases the risk of having a VBAC (ie. scar separation). This is why learning good coping techniques and having a doula can be very helpful. That said, if you need an epidural to help you have a positive birth experience, then by all means, choose that for yourself! 

  1. If you have an epidural, use a peanut ball: Even if someone has an epidural, there are tips and tricks to help increase your chance of a vaginal birth. A peanut-ball is a peanut shaped exercise ball that can be used in a variety of positions to help open up the pelvis and positively influence the positioning of the baby as it’s being born. 


Beware the “VBAC calculator”! Recently, I have been hearing about care providers using a “VBAC calculator”. Different factors about the pregnant person are inputted into an algorithm that is supposed to predict the percent chance of having a vaginal birth. The use of this is a HUGE RED FLAG to me, and if this becomes part of routine OB and midwifery practice I fear that VBAC rates will decrease even further. 

What is wrong with these calculators? 

First, the database of information that these calculators use is from observational data of a specific patient population. The one that care providers in Toronto have been known to use is from a patient population in the United States. American birthing patients and American birth management practices are very different from the birthing patients and birth management practices in Canada. VBAC rates in the US are much lower than VBAC rates in Canada. A hospital with low VBAC rates will produce patients with low VBAC rates and vice versa. So you can already see a discrepancy in applying such a calculator on a random patient. 

These calculators are not evidence based, meaning no study has been done to test the impact of using these calculators to accurately predict actual VBAC success, we also need to study how these calculators impact decision making in both the OB and the patient. 

We are well aware that there is bias in the practice of obstetric medicine, meaning, if a care provider is personally biased in the management of a particular patient, it greatly influences the outcome for that patient. For example, if this VBAC calculator happens to calculate a low success rate, then that can influence the OB to assume that the patient’s attempted VBAC will end up in a c-section. 

Here is a link to an article that explains the research that critiques the use of VBAC calculators.

In any case, the American College of Obstetricians and Gynecologists had this to say about VBAC calculators: “… population-based statistics cannot accurately predict an individual’s VBAC success odds….It is ill-advised to use statistics as a primary indicator when making VBAC decisions.

The role of a doula in your plan to have a TOLAC: The good news is, a doula can navigate at least 5 out of 6 of the positive factors listed. Having the presence of continuous and on-going support from a doula is supported by research to help you avoid a c-section (whether it’s your first childbirth or an attempt at a VBAC). If you are interested in learning more about how a doula could be an integral part of your VBAC team, book a free meet and greet with us today!   

Dr. Ee Von Ling, ND

Want to get prepared for pregnancy, birth and postpartum? Grab our free Bump to Baby Checklist! This clear and thorough guide walks you through everything to expect from your first trimester to past your 6 week postpartum check up.

  • What tests and screenings will be offered and when
  • When to sign up for prenatal education and what types to consider
  • Things you should think about that your care provider may not mention
  • Links to helpful resources

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Things Your Care Provider Can’t Predict

by Dr. Ee Von Ling, ND

Care providers of pregnant people (OB, midwife, nurse and MD) seem to take pride in somehow being able to predict the future of your labour and childbirth. Do they have a special sense or skill set to be able to do this? 

No.  

They are regular humans just like you and me and they are NOT able to predict very much, if anything at all. But they will have you believe that they can. 

Here is a list of the most common things that your pregnancy care provider may try to predict but they cannot possibly know the absolute future: 

  1. When your labour will start. There is no way to know when your labour will start. Not by the size of your pregnant belly. Not if this is your first or second or 5th pregnancy. Not even if they check your cervix at 40 weeks (if you are still pregnant). And yet, we will hear of care providers telling clients that they will have their baby early or go past their due date purely on a personal hunch. 

Did you know that medicine and science don’t really understand how labour spontaneously starts? This always blows my mind because we certainly have many methods of artificially starting labour. We just don’t know the exact mechanism that causes your body to start its own labour. We do have some understanding that the baby influences the start of labour, and this makes sense. When your baby is mature enough to survive and thrive outside, their body secretes proteins from their lungs and brain that can eventually make their way into your blood circulatory system and to your brain. In the brain these signals received from the baby trigger the production of different hormones that prepare and perhaps trigger the body to start labour.  

Around your due date, your care provider may offer to check your cervix. This check is optional and only gives us a snapshot of what is going on with your pregnancy at that moment. Even if your cervix has changed and is showing signs of getting ready (getting soft, moving from posterior to anterior position, starting to dilate by 1 or 2 cm), we can’t tell when labour will start. Even if your baby is low in your pelvis, there is no way to predict when labour will start. 

There is no way to predict when labour will start if this is your first pregnancy or subsequent. Many people hear that first babies come late, and statistically this is somewhat true. According to the US childbirth data available, by 5 days after the due date, 50% of babies of first time parents will be born, and the other 50% are born after this time. What about subsequent babies? By 3 days after the due date, 50% of subsequent babies are born and the rest are born after this time. 

What does this mean? We are born procrastinators (you may groan now). 

There is no way to predict when labour will start according to family history or within the birthin history of the same person. Each pregnancy is different, and this includes when labour will start. That said, research has been able to find some factors that may increase the chance of preterm labour. Some of those factors are genetic and some of those factors are environmental (for example nutrient deficiencies, illnesses, smoking, drinking alcohol or doing drugs while pregnant). 

It may seem harmless to tell a pregnant person that their baby will come early or late. But for that person, such baseless comments can cause unnecessary stress or even cause that person to make pregnancy or childbirth-based decisions that may not be healthy and are certainly not warranted. 

  1. The size of your baby. The only way to get an accurate assessment of your baby’s weight is to weigh the baby after they are born. There is no accurate way to know the exact size of your baby before that. Not by the size of your belly. Not by the amount of weight you have gained. Not by ultrasound assessment.

It is pretty common, although not actually considered a standard part of prenatal care, to be told to get a 3rd trimester ultrasound. The main reasons are to assess the growth of the baby (read: size), amniotic fluid levels and general health of the placenta. Parents will be told, “Your baby is 1234 g”. The care provider might run with this info and say “based on this, your baby will be 4567g at birth. That will be a big baby! You will likely need a c-section”. Then they turn around and leave the room, leaving the pregnant person VERY DISTRAUGHT. 

There is a lot to undo here. First, ultrasound weight measurements are very inaccurate, with at least a 15% margin of error. The inaccuracy of ultrasound to measure weight WORSENS as you get closer to the due date, by at least 20% margin of error. There is no other professional industry that would accept such a high margin of error. Could you imagine if an engineer used tools with such a high margin of error? “I think this bridge will be 50 metres long, give or take 10 metres”. Or if your pharmacist said, “The dose of this medication is 100mg give or take 20 mg”.  Even with acknowledging the margin of error, it is very hard for parents to “unhear” that they may have a large baby. Thinking that a baby is going to be a certain size most definitely influences medical decisions around early induction and choosing c-section.I have had clients choose a c-section based on “big baby” predictions, only to find out the baby was a very average 7-8 pounds. 

Growth in pregnancy is not linear. This means that a snapshot of what is happening now cannot predict what will happen in the future. Weight gain often happens unevenly throughout pregnancy. You or the baby might gain most of your weight during 1 trimester and not as much the next trimester. As long as the placenta is healthy, some babies might be 80 or 90 percentile for weight during much of the pregnancy (according to ultrasounds) and then end up being 50% for their birth weight (real life weight).  

Let’s also not underestimate the amazingness that is your body. I have attended births where the parent vaginally birthed (and often without an epidural), 9, 10 and almost 11 pound babies. We just had no idea of the baby’s weight and just focused on her being able to birth her baby. 

Don’t get me wrong, ultrasounds can be a useful tool to track trends in a pregnancy. We can track over a series of ultrasounds that a baby is growing well, or not well, or is trending on the upper end of the weight charts. We cannot make such a guess based on just one ultrasound picture. Even so, there will still be surprises at birth. No technology that currently exists is perfect. 

Ultrasounds aside, any other comments on a person’s weight related to baby’s size should stop as there is no relationship between the two. In fact, let’s just stop comments on the size of people’s pregnant bodies altogether.  

  1. How long labour will last or how it will progress. When labour starts, your miraculous body is working to eventually accomplish a few things: a) Softening and thinning out the cervix from the firmness of your nose to the stretchiness of a piece of very thin spandex material; b) Drawing open the cervix so that it is fully dilated and “gone; c) shifting the muscles towards the top of the uterus so that they can better move the baby down into the vagina; d) Moving the baby around the pubic born to e) emerge and be born out the opening of the vagina.

There is absolutely no way to accurately predict how long any of these stages will take. Checking the cervix and the station of the baby (how far down they are in relation to a specific point in the pelvis) are a couple of the ways to assess how the labour is progressing. The softening of the cervix (step a) is expressed as a percent with 100% being completely soft and stretchy like a piece of spandex. It takes a lot of work for this to happen and it needs to happen in order for the cervix to open fully. Sometimes the cervix effaces completely first and then the cervix starts to dilate. So if the cervix is only minimally dilated (say only 1 or 2 cm) but it is 100% effaced, that is still a very good sign because the cervix can easily and sometimes quickly dilate to 10cm. 

Other times, the cervix softens a little then dilates a little, then softens a little more and so on. So when checked, the cervix may be 4cm (yay!) dilated but 50% effaced (still good, but more work and time may be needed for the cervix to become completely effaced and dilated). 

There are also those times when me and the birthing team are completely surprised when all of a sudden the parent goes from 5 cm to fully dilated within an hour. 

And while the cervix is changing, the baby is moving downward. The system of assessing this movement is called “stations”. Zero stations means the baby’s head is aligned with a bony landmark within the pelvic called the ischial spines (or simply “spines”). If the baby is higher than this, a negative number is used, like -1 or -2. If the baby is lower than this, it means the baby is descending into the vagina and positive numbers are used + 1, +2 and so on to +5 being the baby’s head is about to be born. In a textbook labour, when the cervix is fully dilated, the baby is at zero station. In real life the cervix can be dilated and the baby is at -2 station (still high), or the cervix can be just 5 cm dilated and the baby is at zero station (quite low). 

All this information just illustrates that there are too many factors in play to be able to predict or dictate how fast a labour should progress. Unfortunately a long held “formula” (called Friedman’s curve) is often quoted: “We expect your cervix to dilate 1 cm every hour.” This rate was created by a Dr. Friedman based on his observation of 500 births in first time labouring women aged 20 – 30 years old in the 1950’s. He was the first to put a timeline on labour and his observed rate of dilation in his limited population of study has been used as a guideline ever since. As you can imagine things have greatly changed since the 1950’s and this very limited view of labour can no longer be applied. To read a full and thorough critique of using Friedman’s curve you can read this article by Evidence Based Birth.

The main point here is that there is a huge range of how long a labour may last. As long as the birthing parent and baby are doing OK and as long as there are signs of labour progressing (cervix is changing, baby is descending), then we just need to afford you the time to allow your body work and make childbirth happen. 

Dr. Ee Von Ling, ND
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Choosing the Best Bottle for Baby

Dr. Sarah Winward, ND

Choosing a bottle can be confusing, especially if you’re planning on primarily breastfeeding/ chestfeeding. You’ve probably heard about nipple confusion or bottle preference and, rightfully, you’re a bit worried about this happening to you! 

As an IBCLC, I regularly support families who use bottles some or all of the time. Here are my tips on what to look for when choosing a bottle for your baby:


  1. Is it comfortable for you to hold?

This has nothing to do with baby, but if you’re planning on using bottles regularly, it needs to be comfortable. Some of the bottles on the market that are designed to “mimic” breasts are not remotely ergonomic. I recommend holding a few of different sizes to see what feels best for you.


  1. The nipple should be long with a wide base, not “nubby”.

These are the 2 general shapes you’ll see for both bottle nipples and pacifiers. A “nubby” nipple often encourages babies to have a very shallow latch, because their mouths rest comfortably around the nub and their lips end up on the smallest part. You want your baby to have a wide open mouth to avoid pain with nursing, these types of bottles are not doing you any favours. Try to find a nipple that is longer with a wide base. When you’re bottle feeding make sure your baby’s mouth is fully down around the base of the nipple so their mouth is wide open.


  1. Look for a slow flow nipple.

Bottle preference generally happens because bottles have very fast flow. While bodyfeeding, you have to ask for the milk to flow in order to get it going. If you tip a bottle upside down milk will drip out the nipple. When a slower flow nipple, you get less of that dripping because the hole is smaller. That means it’s going to be less overwhelming for baby if you do tip it up and it means that baby has to work to get the milk moving. 


The biggest thing to remember is that HOW YOU FEED YOUR BABY MATTERS THE MOST. Paced bottle feeding is a bottle feeding technique that mimics the flow of milk from the breast. We have an article on how to pace a bottle, including a video here.